tbuckley/cabot-search huggingface dataset:
Super Enhancer–Regulated LncRNA LINC01089 Induces Alternative Splicing of <i>DIAPH3</i> to Drive Hepatocellular Carcinoma Metastasis
Authors: Tao Su, Nasha Zhang, Teng Wang, Jiajia Zeng, Wenwen Li, Linyu Han, Ming Yang
Journal: Cancer Research (2023)

Abstract Hepatocellular carcinoma (HCC) is one of the most lethal neoplasms and has a 5-year survival rate of only 18% in patients with metastatic diseases. Epigenetic modifiers and alterations, including histone modifications, long noncoding RNAs (lncRNA), RNA alternative splicing, and N6-methyladenosine (m6A) modification, are key regulators of HCC development, highlighting the importance of understanding the cross-talk between these biological processes. In the current study, we identified LINC01089 as a super enhancer (SE)–driven lncRNA that promotes epithelial–mesenchymal transition (EMT), migration, invasion, and metastasis of HCC cells in vivo and in vitro. The transcription factor E2F1 bound to a LINC01089 SE, promoting LINC01089 transcription and overexpression. LINC01089 interacted with heterogeneous nuclear ribonucleoprotein M (hnRNPM) and led to hnRNPM-mediated skipping of DIAPH3 exon 3. Knockdown of LINC01089 increased the inclusion of DIAPH3 exon 3, which contains an important m6A-modification site that is recognized by IGF2BP3 to increase DIAPH3 mRNA stability. Thus, LINC01089 loss increased DIAPH3 protein levels, which suppressed the ERK/Elk1/Snail axis and inhibited EMT of HCC cells. In conclusion, this study revealed cross-talk between different epigenetics modifiers and alterations that drives HCC progression and identified LINC01089 as a potential prognostic marker and therapeutic target for HCC. Significance: LINC01089 is a super enhancer–driven long noncoding RNA that induces ERK signaling and epithelial–mesenchymal transition by regulating DIAPH3 alternative splicing that blocks N6-methyladenosine–mediated mRNA stabilization, establishing an epigenetic network that promotes hepatocellular carcinoma metastasis.
Association of Unmet Social Needs With Metformin Use Among Patients With Type 2 Diabetes
Authors: Connor Drake, Jorge Morales Alfaro, Dan V. Blalock, Kristin Ito, Bryan C. Batch, Hayden B. Bosworth, Seth A. Berkowitz, Leah L. Zullig
Journal: Diabetes Care (2023)

OBJECTIVE To evaluate the relationship between social needs and metformin use among adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS In a prospective cohort study of adults with T2D (n = 722), we linked electronic health record (EHR) and Surescripts (Surescripts, LLC) prescription network data to abstract data on patient-reported social needs and to calculate metformin adherence based on expected refill frequency using a proportion of days covered methodology. RESULTS After adjusting for demographics and clinical complexity, two or more social needs (−0.046; 95% CI −0.089, 0.003), being uninsured (−0.052; 95% CI −0.095, −0.009) and while adjusting for other needs, being without housing (−0.069; 95% CI −0.121, −0.018) and lack of access to medicine/health care (−0.058; 95% CI −0.115, −0.000) were associated with lower use. CONCLUSIONS We found that overall social need burden and specific needs, particularly housing and health care access, were associated with clinically significant reductions in metformin adherence among patients with T2D.
Langerhans Cell Histiocytosis With Thyroid Involvement on 18F-FDG PET/MR
Authors: Hwan Lee, Lisa J. States
Journal: Clinical Nuclear Medicine (2023)

An 18-month-old otherwise healthy girl presented with 1 month of neck swelling. Based on ultrasonography that showed diffusely enlarged heterogeneous thyroid gland, a presumed diagnosis of thyroid cancer was made. Subsequent core needle biopsy revealed Langerhans cell histiocytosis extensively involving the thyroid. 18 F-FDG PET/MR was performed for staging and to evaluate the local extent of the disease in the neck. PET/MR demonstrated a hypermetabolic neck mass inseparable from the thyroid gland. The mass encased the major vessels, trachea, and esophagus without compression or invasion. Osseous involvement was excluded by both skeletal survey and PET/MR.
Partial Radiation Nephrectomy Using 90Y Resin Microspheres: A Treatment Option for Renal Tumors With Malignant Characteristics in Patients Not Candidates for Surgery
Authors: Miguel Sogbe, Macarena Rodríguez-Fraile, Antonio Martínez de la Cuesta, Fernando Rotellar, Mercedes Iñarrairaegui
Journal: Clinical Nuclear Medicine (2023)

Abstract Contrast-enhancing renal masses are likely to be malignant in over 90% of cases due to the high diagnostic accuracy of abdominal imaging. In this situation, tumor biopsy is unnecessary and should be managed as a renal cell carcinoma. Resection remains the only potentially curative treatment. However, as in the case herein presented, comorbidities can prevent surgical resection. Radioembolization with 90 Y microspheres is an intra-arterial procedure capable of delivering high doses of radiation to tumors. The present case demonstrates the concept of partial radiation nephrectomy in treating renal tumors with malignant characteristics in patients not amenable to surgery.
68Ga-PSMA–Avid Liver Metastases From Colon Cancer, Not Visualized on FDG PET Scan
Authors: Abtin Doroudinia, Satyanarayana Chekuri
Journal: Clinical Nuclear Medicine (2023)

18 F-FDG PET/CT scan is a well-known modality to assess distant metastases and treatment response in the patients with primary colon cancer. We are presenting an interesting case of 68 Ga-PSMA-avid liver metastases in a 74-year-old man with colon cancer and recently diagnosed prostate cancer. The liver metastases were positive on initial FDG PET but lost FDG avidity on subsequent posttreatment FDG PET scans. Biopsy from the PSMA-avid liver lesions confirmed metastasis from colon origin. PSMA is expressed in various forms of tumor neovasculature other than prostate cancer with potential new applications as a theranostic agent in the future.
Prediction of Cardiometabolic Health Through Changes in Plasma Proteins With Intentional Weight Loss in the DiRECT and DIADEM-I Randomized Clinical Trials of Type 2 Diabetes Remission
Authors: Naveed Sattar, Shahrad Taheri, David P. Astling, Jessica Chadwick, Michael A. Hinterberg, Michael V. Holmes, Emma V. Troth, Paul Welsh, Hadeel Zaghloul, Odette Chagoury, Mike Lean, Roy Taylor, Steve Williams
Journal: Diabetes Care (2023)

OBJECTIVE To determine the extent to which changes in plasma proteins, previously predictive of cardiometabolic outcomes, predict changes in two diabetes remission trials. RESEARCH DESIGN AND METHODS We applied SomaSignal predictive tests (each derived from ∼5,000 plasma protein measurements using aptamer-based proteomics assay) to baseline and 1-year samples of trial intervention (Diabetes Remission Clinical Trial [DiRECT], n = 118, and Diabetes Intervention Accentuating Diet and Enhancing Metabolism [DIADEM-I], n = 66) and control (DiRECT, n = 144, DIADEM-I, n = 76) group participants. RESULTS Mean (SD) weight loss in DiRECT (U.K.) and DIADEM-I (Qatar) was 10.2 (7.4) kg and 12.1 (9.5) kg, respectively, vs. 1.0 (3.7) kg and 4.0 (5.4) kg in control groups. Cardiometabolic SomaSignal test results showed significant improvement (Bonferroni-adjusted P &amp;lt; 0.05) in DiRECT and DIADEM-I (expressed as relative difference, intervention minus control) as follows, respectively: liver fat (−26.4%, −37.3%), glucose tolerance (−36.6%, −37.4%), body fat percentage (−8.6%, −8.7%), resting energy rate (−8.0%, −5.1%), visceral fat (−34.3%, −26.1%), and cardiorespiratory fitness (9.5%, 10.3%). Cardiovascular risk (measured with SomaSignal tests) also improved in intervention groups relative to control, but this was significant only in DiRECT (DiRECT, −44.2%, and DIADEM-I, −9.2%). However, weight loss &amp;gt;10 kg predicted significant reductions in cardiovascular risk, −19.1% (95% CI −33.4 to −4.91) in DiRECT and −33.4% (95% CI −57.3, −9.6) in DIADEM-I. DIADEM-I also demonstrated rapid emergence of metabolic improvements at 3 months. CONCLUSIONS Intentional weight loss in recent-onset type 2 diabetes rapidly induces changes in protein-based risk models consistent with widespread cardiometabolic improvements, including cardiorespiratory fitness. Protein changes with greater (&amp;gt;10 kg) weight loss also predicted lower cardiovascular risk, providing a positive outlook for relevant ongoing trials.
Nonfluent Variant Primary Progressive Aphasia on FDG, 11C-PIB, and 18F-APN-1607 PET Imaging
Authors: Lingchao Li, Bin Ji, Min Zhao, Lin Bai, Bin Chen
Journal: Clinical Nuclear Medicine (2023)

Abstract A 61-year-old right-handed man presented with decreased cognitive function, short-term memory, fluent speech disorders, and grammatical errors for 1 year. The patient underwent PET imaging with 11 C-PIB, 18 F-FDG, and 18 F-APN-1607. The 11 C-PIB PET showed no amyloid accumulation; the 18 F-FDG PET showed hypometabolism in the bilateral frontal lobe, temporal lobe, and midbrain; and the 18 F-APN-1607 PET showed tau accumulation in the brainstem, basal ganglia, and left inferior frontal gyrus. These findings suggested a diagnosis of nonfluent variant primary progressive aphasia. This case emphasizes the value of combined imaging of glucose metabolism, Aβ, and tau PET in the diagnosis of nonfluent variant primary progressive aphasia.
Clonal Hematopoiesis of Indeterminate Potential (CHIP) and Incident Type 2 Diabetes Risk
Authors: Deirdre K. Tobias, Alisa K. Manning, Jennifer Wessel, Sridharan Raghavan, Kenneth E. Westerman, Alexander G. Bick, Daniel Dicorpo, Eric A. Whitsel, Jason Collins, Adolfo Correa, L. Adrienne Cupples, Josée Dupuis, Mark O. Goodarzi, Xiuqing Guo, Barbara Howard, Leslie A. Lange, Simin Liu, Laura M. Raffield, Alex P. Reiner, Stephen S. Rich, Kent D. Taylor, Lesley Tinker, James G. Wilson, Peitao Wu, April P. Carson, Ramachandran S. Vasan, Myriam Fornage, Bruce M. Psaty, Charles Kooperberg, Jerome I. Rotter, James Meigs, JoAnn E. Manson
Journal: Diabetes Care (2023)

OBJECTIVE Clonal hematopoiesis of indeterminate potential (CHIP) is an aging-related accumulation of somatic mutations in hematopoietic stem cells, leading to clonal expansion. CHIP presence has been implicated in atherosclerotic coronary heart disease (CHD) and all-cause mortality, but its association with incident type 2 diabetes (T2D) is unknown. We hypothesized that CHIP is associated with elevated risk of T2D. RESEARCH DESIGN AND METHODS CHIP was derived from whole-genome sequencing of blood DNA in the National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine (TOPMed) prospective cohorts. We performed analysis for 17,637 participants from six cohorts, without prior T2D, cardiovascular disease, or cancer. We evaluated baseline CHIP versus no CHIP prevalence with incident T2D, including associations with DNMT3A, TET2, ASXL1, JAK2, and TP53 variants. We estimated multivariable-adjusted hazard ratios (HRs) and 95% CIs with adjustment for age, sex, BMI, smoking, alcohol, education, self-reported race/ethnicity, and combined cohorts’ estimates via fixed-effects meta-analysis. RESULTS Mean (SD) age was 63.4 (11.5) years, 76% were female, and CHIP prevalence was 6.0% (n = 1,055) at baseline. T2D was diagnosed in n = 2,467 over mean follow-up of 9.8 years. Participants with CHIP had 23% (CI 1.04, 1.45) higher risk of T2D than those with no CHIP. Specifically, higher risk was for TET2 (HR 1.48; CI 1.05, 2.08) and ASXL1 (HR 1.76; CI 1.03, 2.99) mutations; DNMT3A was nonsignificant (HR 1.15; CI 0.93, 1.43). Statistical power was limited for JAK2 and TP53 analyses. CONCLUSIONS CHIP was associated with higher incidence of T2D. CHIP mutations located on genes implicated in CHD and mortality were also related to T2D, suggesting shared aging-related pathology.
Epigenome-Wide Meta-analysis Reveals Associations Between Dietary Glycemic Index and Glycemic Load and DNA Methylation in Children and Adolescents of Different Body Sizes
Authors: Raffael Ott, Robert Stein, Helena H. Hauta-alus, Justiina Ronkainen, Sílvia Fernández-Barrés, Ulrike Spielau, Holger Kirsten, Tanja Poulain, Phillip E. Melton, Leanne K. Küpers, Hatim Azaryah, Marco Colombo, Kathrin Landgraf, Elmar W. Tobi, Therese O’Sullivan, Rae-Chi Huang, Cristina Campoy, Christiane Winkler, Jesus Vioque, Martine Vrijheid, Wieland Kiess, Antje Körner, Sylvain Sebert, Marjo-Riitta Jarvelin, Anette-G. Ziegler, Sandra Hummel
Journal: Diabetes Care (2023)

OBJECTIVE Dietary glycemic index (GI) and glycemic load (GL) are associated with cardiometabolic health in children and adolescents, with potential distinct effects in people with increased BMI. DNA methylation (DNAm) may mediate these effects. Thus, we conducted meta-analyses of epigenome-wide association studies (EWAS) between dietary GI and GL and blood DNAm of children and adolescents. RESEARCH DESIGN AND METHODS We calculated dietary GI and GL and performed EWAS in children and adolescents (age range: 4.5–17 years) from six cohorts (N = 1,187). We performed stratified analyses of participants with normal weight (n = 801) or overweight or obesity (n = 386). We performed look-ups for the identified cytosine–phosphate–guanine (CpG) sites (false discovery rate [FDR] &amp;lt;0.05) with tissue-specific gene expression of 832 blood and 223 subcutaneous adipose tissue samples from children and adolescents. RESULTS Dietary GL was positively associated with DNAm of cg20274553 (FDR &amp;lt;0.05), annotated to WDR27. Several CpGs were identified in the normal-weight (GI: 85; GL: 17) and overweight or obese (GI: 136; GL: 298; FDR &amp;lt;0.05) strata, and none overlapped between strata. In participants with overweight or obesity, identified CpGs were related to RNA expression of genes associated with impaired metabolism (e.g., FRAT1, CSF3). CONCLUSIONS We identified 537 associations between dietary GI and GL and blood DNAm, mainly in children and adolescents with overweight or obesity. High-GI and/or -GL diets may influence epigenetic gene regulation and thereby promote metabolic derangements in young people with increased BMI.
Unilateral Chronic Parotitis With 68Ga-DOTA-FAPI-04 PET/CT and 18F-FDG PET/CT Imaging in a Case of a Patient With Papillary Thyroid Carcinoma
Authors: Vahid Roshanravan, Ramin Sadeghi, Seyed Rasoul Zakavi, Nasim Norouzbeigi, Atena Aghaee
Journal: Clinical Nuclear Medicine (2023)

The 68 Ga-FAPI (fibroblast activation protein inhibitor) radiotracer is a novel and versatile tool in nuclear medicine, exhibiting potential for use in various conditions due to its significant upregulation in cancerous and inflammatory conditions, particularly those involving fibrotic and infectious processes. In this report, we present the case of a patient with papillary thyroid carcinoma who underwent total thyroidectomy and iodine therapy. He was referred because of high thyroglobulin despite negative diagnostic radioiodine imaging (TENIS syndrome). The patient underwent 18 F-FDG and 68 Ga-DOTA-FAPI-46 PET/CT imaging for metastatic workup and treatment planning. FAPI uptake was observed in the right parotid gland (with no FDG uptake), prompting a 99m TcO 4- salivary scintigraphy. Subsequently, a diagnosis of chronic sialadenitis was made.
Upregulation of Indoleamine 2,3-Dioxygenase 1 in Tumor Cells and Tertiary Lymphoid Structures is a Hallmark of Inflamed Non–Small Cell Lung Cancer
Authors: Alban Bessede, Florent Peyraud, Sylvestre Le Moulec, Sophie Cousin, Mathilde Cabart, François Chomy, Christophe Rey, Oren Lara, Ophélie Odin, Imane Nafia, Jean-Philippe Guegan, Antoine Italiano
Journal: Clinical Cancer Research (2023)

Abstract Purpose: Overexpression of the tryptophan-catabolizing enzyme indoleamine 2,3-dioxygenase 1 (IDO1) has been reported in several tumor types, including non–small cell lung cancer (NSCLC), and has been shown to promote tumor-immune evasion and inhibit T-cell activation through increased tryptophan degradation and the production of several immunosuppressive metabolites collectively known as kynurenines. However, it remains unclear whether IDO1 expression by tumor cells is detrimental specifically in the context of programmed cell death protein 1 (PD-1)/programmed death ligand 1 (PD-L1) axis blockade. Experimental Design: We analyzed the transcriptome of 891 NSCLC tumor samples from patients enrolled in two large randomized clinical trials investigating the safety and activity of atezolizumab, a humanized IgG1 mAb that targets PD-L1, versus docetaxel in patients with advanced NSCLC. We complemented these transcriptomics results at the protein level by using multiplex immunofluorescence and at the functional level with in vitro experiments. Results: The increased expression of the tryptophan-catabolizing enzyme IDO1 was significantly associated with improved objective response, progression-free survival, and overall survival in patients treated with PD-L1 inhibitors, but not in those treated with chemotherapy. Strikingly, inflamed tumors had higher levels of IDO1, and IDO1 was also expressed in tertiary lymphoid structures (TLS) by mature follicular dendritic cells. L-kynurenine impaired the differentiation of antibody-producing B cells induced by follicular helper T (Tfh)/B-cell interactions, a hallmark process within TLS. Conclusions: IDO1 pathway in NSCLC is driven by the immune system rather than by tumor cells. Targeting IDO1 in combination with anti–PD-1/PD-L1 might be beneficial only in patients with inflamed tumors and particularly in those bearing TLS.
Leptomeningeal Metastasis From Neuroblastoma Revealed by 123I-MIBG SPECT/CT
Authors: Lijuan Feng, Xia Lu, Wei Wang, Jigang Yang
Journal: Clinical Nuclear Medicine (2023)

Abstract A 2-year-old girl with history of high-risk neuroblastoma underwent 123 I-MIBG, which showed increased 123 I-MIBG in the left side of the head. Contrast-enhanced MRI and cerebral spine fluid cytology confirmed the diagnosis of leptomeningeal metastasis.
Steroids May Be Associated With Extensive Skeletal Muscle Uptake of 18F-FDG
Authors: Kazuna Kawabata, Makoto Hosono, Yukiko Mori, Suzune Tsukamoto, Shunsuke Ito, Saya Ando, Mitsunori Kanagaki
Journal: Clinical Nuclear Medicine (2023)

The possibility of steroid administration inducing the extensive skeletal muscle uptake (ESMU) of FDG in PET scans was investigated.From 8923 consecutive 18 F-FDG PET/CT scans taken at our hospital, 23 scans (15 patients) met adult age and ESMU-positive inclusion criteria. Among the 15 patients, 13 with both ESMU-positive and -negative scans were examined for association with steroid administration.Extensive skeletal muscle uptake was associated with a history of steroid administration ( χ2 test: P = 0.001). Notably, 20 ESMU-positive scans and 11 ESMU-negative scans were significantly different, with 0 to 95 days (median, 18.5 days) and 0 to 708 days (median, 319.0 days) since the last steroid administration, respectively (Mann-Whitney U test, P = 0.003). A significant correlation was observed between mean skeletal muscle SUV max and the number of days since the last steroid administration (Spearman rank correlation coefficient, ρ = -0.501, P = 0.004). Specifically, the degree of ESMU tended to decrease over time, after steroid administration. From multiple regression analysis, the number of days since the last steroid administration was significantly associated with mean SUV max ( P = 0.007), but the blood glucose level was not significant ( P = 0.204), revealing that the number of days since the last steroid administration was an independent risk factor. Multicollinearity was low (the variance inflation factor was 1.007 for both the number of days since the last steroid administration and blood glucose levels).Steroid administration within months before PET may be one cause of ESMU.
Hypoxic Bone Marrow Stromal Cells Secrete miR-140–5p and miR-28–3p That Target SPRED1 to Confer Drug Resistance in Multiple Myeloma
Authors: Hui Zhang, Zhimin Du, Chenggong Tu, Xinyan Zhou, Eline Menu, Jinheng Wang
Journal: Cancer Research (2023)

Abstract Bone marrow stromal cell (BMSC)–derived small extracellular vesicles (sEV) promote drug resistance to bortezomib in multiple myeloma cells. Elucidating the components of BMSC sEV that induce drug resistance in multiple myeloma cells could help identify strategies to overcome resistance. Considering the hypoxic nature of the myeloma microenvironment, we explored the role of hypoxia in regulating BMSC sEV cargo and investigated whether hypoxia-driven sEV miRNAs contribute to the drug resistance in multiple myeloma cells. Hypoxia increased the release of sEVs from BMSCs, and these sEVs more strongly attenuated bortezomib sensitivity in multiple myeloma cells than sEVs from BMSCs under normoxic conditions. RNA sequencing revealed that significantly elevated levels of miR-140–5p and miR-28–3p were enclosed in hypoxic BMSC-derived sEVs. Both miR-140–5p and miR-28–3p conferred bortezomib resistance in multiple myeloma cells by synergistically targeting SPRED1, a member of the Sprouty protein family that regulates MAPK activation. SPRED1 inhibition reduced sensitivity to bortezomib in multiple myeloma cells through activating MAPK-related pathways and significantly promoted multiple myeloma bortezomib resistance and tumor growth in a mouse model. These findings shed light on the role of hypoxia-induced miRNAs shuttled in BMSC-derived sEVs to multiple myeloma cells in inducing drug resistance and identify the miR-140–5p/miR-28–3p/SPRED1/MAPK pathway as a potential targetable axis for treating multiple myeloma. Significance: Hypoxia induces stromal cells to secrete extracellular vesicles with increased miR-140–5p and miR-28–3p that are transferred to multiple myeloma cells and drive drug resistance by increasing the MAPK signaling.
Metastatic Esophageal Adenocarcinoma Showing 68Ga-DOTATATE Uptake
Authors: Nuh Fılızoglu, Salih Ozguven
Journal: Clinical Nuclear Medicine (2023)

The role of 68 Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well defined. Nevertheless, 68 Ga-DOTATATE uptake may be seen in some tumors other than neuroendocrine tumors as a reflection of tumor blood supply and somatostatin receptor expression. Although 68 Ga-DOTATATE uptake has been described in a number of nonneuroendocrine tumors, no case of 68 Ga-DOTATATE uptake in esophagus adenocarcinoma has been reported. We present the case of a 52-year-old man who had a metastatic esophageal adenocarcinoma showing 68 Ga-DOTATATE uptake.
Impact of 18F-FDG PET on the Management in Patients With Recurrent Gynecologic cancer
Authors: Kyoungjune Pak, Hai-Jeon Yoon
Journal: Clinical Nuclear Medicine (2023)

Purpose Gynecological cancer is the most prevalent cancer among women worldwide. We performed a meta-analysis to assess the impact of 18 F-FDG PET on the management of patients with recurrent gynecological cancers, including cervical, uterine, and ovarian cancers. Methods We systematically searched MEDLINE and EMBASE databases for English-language publications. All published studies on the impact of PET scans on the management of patients with recurrent gynecological cancers were reviewed. The proportion of management change (%), defined as the percentage of patients whose management changed after FDG PET to those who underwent FDG PET, was calculated. The data from each study were analyzed using MedCalc Statistical Software version 14.12.0 (MedCalc Software, Ostend, Belgium). Results Nineteen studies including 6191 patients were eligible for inclusion. The impact of FDG PET scan for detecting recurrence/metastasis in patients with gynecologic cancer was evaluated using management change rates, ranging from 9.4% to 60.7% with a pooled effect of 42.0% (95% confidence interval [CI], 34.5%–49.6%; I 2 = 92.9%). In the subtype analysis, FDG PET scanning resulted in changes in the management in 48.5% (95% CI, 37.8%–59.3%; I 2 = 67.8%) of cervical cancer, 34.7% (95% CI, 33.4%–36.0%; I 2 = 0%) of uterine cancer, and 40.3% (95% CI, 26.7%–54.7%; I 2 = 95.2%) of ovarian cancer cases. Conclusions FDG PET has a significant impact on the restaging of patients with gynecological cancer. These findings suggest that FDG PET should be performed, especially in cases of suspected recurrence/metastasis in the main gynecologic cancer types, including cervical, ovarian, and uterine cancers.